Abstract 608: Uric Acid Potentially Interacts With Parathyroid Hormone To Promote Left Ventricular Diastolic Dysfunction In Mice Fed A Western Diet

Hypertension ◽  
2014 ◽  
Vol 64 (suppl_1) ◽  
Author(s):  
Guanghong Jia ◽  
Brian P Bostick ◽  
Javad Habibi ◽  
Annayya R. Aroor ◽  
Vincent G. DeMarco ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Weight ◽  
Uric Acid ◽  
Parathyroid Hormone ◽  
Diastolic Dysfunction ◽  
Cardiac Mri ◽  
Left Ventricular ◽  
Western Diet ◽  
P Value ◽  
Lv Diastolic Dysfunction

Hyperuricemia is frequently observed in obese people and rising obesity rates parallel increased consumption of a high-fat/high-fructose western diet (WD). Epidemiologic and clinical data suggest that serum uric acid (UA) is positively associated with serum parathyroid hormone (PTH) and may be linked with left ventricular (LV) hypertrophy and LV diastolic dysfunction. Accordingly, we hypothesized that allopurinol, a potent xanthine oxidase (XO) inhibitor, would prevent development of LV diastolic dysfunction, independent of blood pressure, by reducing the levels of UA and PTH. Four week-old C57BL6/J male mice were fed a WD and water with 125mg/L allopurinol. After 16 weeks, we assessed levels of UA, XO activity, PTH, as well as diastolic function by cardiac MRI and cardiac ultrastructure by transmission electron microscopy (TEM). Body weight and fat composition were obtained along with HOMA -IR testing for insulin resistance. Allopurinol has been show to exert no effect on blood pressure. High resolution cardiac MRI revealed diastolic dysfunction with WD feeding that was prevented by allopurinol (LV diastolic relaxation time 35.3 ms for WD, 25.4 ms for CD and 27.7 ms for WD+ allopurinol, p value <0.01; Initial filling rate 0. 28 μl/ms for WD, 0.43 μl/ms for CD and 0.42 μl/ms for WD+ allopurinol, p value <0.05). Body weight, fat mass, and HOMA-IR were increased by WD feeding but not significantly improved by allopurinol. However, allopurinol markedly decreased the WD-induced increase in heart weight associated with activation of translational S6 kinase. TEM examination of myocardial ultrastructure revealed that WD induced remodeling changes with large mitochondria with disordered cristae and increased lysosomes. The ultrastructural changes were improved with treatment by allopurinol. Furthermore, allopurinol significantly inhibited both of plasma and urine UA levels and cardiac XO activity caused by WD. Interestingly , WD increased PTH levels which were decreased in parallel with reductions in uric acid with allopurinol. These findings support the notion that increased plasma levels of UA, in concert with elevated PTH, may play a key role in LV hypertrophy and associated LV diastolic dysfunction that result from consuming a WD high in fructose and fat.

P937Impact of left ventricular diastolic dysfunction on long-term outcome in patients with lower extremity artery disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Yanaka ◽  
H Akahori ◽  
T Imanaka ◽  
K Miki ◽  
N Yoshihara ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Diastolic Dysfunction ◽  
Primary Endpoint ◽  
Left Ventricular ◽  
P Value ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Artery Disease ◽  
Lv Diastolic Dysfunction

Abstract Background Left ventricular (LV) systolic dysfunction and heart failure (HF) in patients with lower extremity artery disease (LEAD) is associated with an increased risk for adverse events. However, relationship between long-term outcome in patient with LEAD and LV diastolic dysfunction remains unclear. Purpose The aim of this study was to assess the impact of LV diastolic dysfunction on long-term outcome in patients with LEAD. Methods Two hundred patients (male 66%, mean age 76±9 years) with preserved LV systolic function assessed by echocardiography (ejection fraction ≥50%) were enrolled from a single-center database between January 2013 to May 2015. Baseline LEAD was identified by ABI <0.9 or history of lower extremity revascularization. Diagnosis of LV diastolic dysfunction was based on the ASE/EACVI guidelines. The 3-year cumulative incidence of primary endpoint compared between LEAD patients with LV diastolic dysfunction than those without. The primary endpoint was a composite of cardiovascular death, myocardial infarction, stroke and hospitalization for HF during 3 years follow-up. Multivariate analysis was performed to determine whether LV diastolic dysfunction was independently associated with the primary endpoint. Results LV diastolic dysfunction was identified in 31%. The mean observation period was 32±21 months. The primary endpoint occurred more frequently in patients with LV diastolic dysfunction than those without at 3 years (30% vs 16%, P=0.02). There were no significant differences between 2 groups in the myocardial infarction (3% vs 3%, P=0.73) and stroke (3% vs 3%, P=0.55). Cardiovascular death (19% vs 7%, P=0.01) and hospitalization for HF (19% vs 7%, P=0.01) were significantly higher in patients with LV diastolic dysfunction. In multivariate analysis, LV diastolic dysfunction was an independent predictor for primary endpoint (HR=2.28, 95% CI 1.10–4.73, P=0.02) (Table) Predictor for primary endpoint Factors Univariate model Multivariate model Hazard ratio [95% CI] P value Hazard ratio [95% CI] P value Age 1.03 [0.98–1.08] 0.24 1.03 [0.98–1.08] 0.22 Chronic kidney disease 1.53 [0.77–3.07] 0.23 1.25 [0.60–2.58] 0.55 Coronary artery disease 1.08 [0.53–2.18] 0.84 1.18 [0.56–2.50] 0.65 Cerebrovascular disease 1.93 [0.74–5.02] 0.17 2.28 [0.86–6.05] 0.10 Critical limb ischemia 3.75 [1.68–8.37] <0.01 3.72 [0.56–2.50] <0.01 LV diastolic dysfunction 2.37 [1.18–4.74] 0.02 2.28 [1.10–4.73] 0.03 Conclusions LV diastolic dysfunction increased the risk for adverse events in patients with LEAD. Acknowledgement/Funding None

Abstract 14069: Subclinical Impairment of Left Ventricular Function in Stage A Subjects in a Community-based Population

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Takuya Hasegawa ◽  
Masanori Asakura ◽  
Hideaki Kanzaki ◽  
Hiroshi Asanuma ◽  
Seiji Takashio ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Dysfunction ◽  
Left Ventricular ◽  
Community Dwelling ◽  
Lv Function ◽  
Mitral Annular Velocity ◽  
Lv Mass ◽  
Lv Diastolic Dysfunction

Introduction: Stage A heart failure (HF) is defined as an asymptomatic state with HF risk factors of hypertension, diabetes, obesity, metabolic syndrome, and atherosclerotic disease in the absence of obvious left ventricular (LV) structural changes including LV hypertrophy (LVH). ACC/AHA guidelines recommend us to treat these risk factors of Stage A HF patients to prevent the progression of HF, hinting us to investigate the prevalence of subclinical impairment of LV function in Stage A subjects in general populations. Methods: We studied 1162 community-dwelling subjects without obvious heart diseases (mean age, 63±11 years; 448 men, 714 women, 63% with hypertension and 11% with diabetes) in the annual health checkup in a rural community, Arita-cho, Saga, Japan. The population was divided into 3 groups; the subjects without either LVH or the HF risk factors ("Stage 0"), the subjects with the HF risk factors in the absence of LVH (Stage A) , and the subjects in the presence of LVH (Stage B). LV systolic and diastolic function were estimated by mitral annular velocity in systole (s'), and the waves of transmitral flow (E) and mitral annular velocity (e'), respectively. LVH was defined as the top quintile of LV mass index. Results: The subjects in Stage A had the lower and higher values of s' and E/e', respectively, and the higher prevalence of LV diastolic dysfunction than those in Stage 0, while 45% of Stages A subjects showed LV diastolic dysfunction (Table). In multivariate logistic analyses, age, systolic blood pressure and LV mass were independent determinants of s', whereas either overlapped or different risk factors, such as age, sex, systolic blood pressure, and body mass index emerged as the determinants for E/e'. Conclusions: Even without obvious LV remodeling, subclinical LV systolic and diastolic impairment was observed in Stage A subjects. The disparity of the risk factors between LV systolic and diastolic dysfunction may indicate their pathophysiological differences.

P2488The 2013 ACC/AHA pooled cohort equations and insulin resistance status for detection of early-stage heart failure in the community

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Cauwenberghs ◽  
K Hedman ◽  
Y Kobayashi ◽  
F Haddad ◽  
T Kuznetsova
Keyword(s):  
Insulin Resistance ◽  
Diastolic Dysfunction ◽  
Risk Score ◽  
Early Stage ◽  
Left Ventricular ◽  
P Value ◽  
Net Reclassification Improvement ◽  
Ascvd Risk ◽  
Lv Diastolic Dysfunction ◽  
Integrated Discrimination Improvement

Abstract Objectives Detection of heart failure (HF) in its subclinical phase would allow timely initiation of preventive measures that counter its pathophysiology. Here, we assessed the usefulness of traditional cardiovascular (CV) risk assessment and insulin resistance status to detect early-stage HF. Methods In 984 participants (mean age, 57.0 years, 52.3% women), we derived echocardiographic indexes of left ventricular (LV) structure and function and calculated the 10-year risk for a first atherosclerotic CV disease (ASCVD) using the 2013 ACC/AHA risk score. We assessed the discriminatory value of this risk score to detect LV maladaptation and the improvements in reclassification by insulin resistance status (HOMA-IR). Results The probability for LV maladaptation rose progressively with the 10-year ASCVD risk increasing. Participants at high 10-year ASCVD risk (>7.5%) had indeed significantly higher odds for LV concentric remodeling (odds ratio, 4.84), LV hypertrophy (OR, 5.93), abnormal LV longitudinal strain (OR, 2.04) and LV diastolic dysfunction (OR, 25.3) as compared to those at low ASCVD risk (<2.5%; P≤0.0003). Adding markers of insulin resistance to the ACC/AHA risk score moderately improved the integrated discrimination and net reclassification of all LV maladaptive phenotypes (P≤0.022) except LV diastolic dysfunction (P≥0.059). LV remodeling and abnormal LS was particularly more likely in insulin-resistant participants with a 10-year ASCVD risk between 5% and 15% than in their insulin-sensitive counterparts. Prediction of early-stage HF profiles 2013 ACC/AHA risk score Addition of insulin resistance status to the 2013 ACC/AHA risk score AUC (95% CI) Integrated Discrimination Improvement Net Reclassification Improvement Absolute IDI (%) P value NRI (95% CI) P value LV concentric remodeling 0.70 (0.66 to 0.74) 0.0083 (11.3%) 0.022 0.23 (0.067 to 0.39) 0.0058 LV hypertrophy 0.70 (0.66 to 0.74) 0.017 (20.7%) 0.0033 0.27 (0.11 to 0.43) 0.0011 Abnormal LV LS 0.56 (0.53 to 0.62) 0.022 (202.0%) <0.0001 0.33 (0.18 to 0.49) <0.0001 LV diastolic dysfunction 0.82 (0.78 to 0.86) 0.0007 (0.45%) 0.84 0.093 (−0.11 to 0.30) 0.38 ≥2 LV abnormalities 0.76 (0.72 to 0.80) 0.0087 (7.3%) 0.071 0.22 (0.042 to 0.40) 0.016 The integrated discrimination improvement (IDI) and net reclassification improvement (NRI) reflect the improvements in classification by adding insulin resistance (by HOMA-IR) to the 2013 ACC/AHA risk score. HOMA-IR, Homeostatic Model for Assessment of Insulin Resistance; LS, longitudinal strain; LV, left ventricular. Risk enhancers of LV maladaptation Conclusions The 2013 ACC/AHA risk score adequately captured the risk for echocardiographic phenotypes of early-stage HF. As risk enhancer, insulin resistance might improve risk stratification of subclinical HF in subjects at intermediate risk. Acknowledgement/Funding The European Union, European Research Council and the Flanders Scientific Research Fund supported this study.

scholarly journals Echocardiographic Assessment of Cardiac Dysfunction in Patients of Chronic Kidney Disease on Maintenance Hemodialysis

2019 ◽  
Vol 17 (2) ◽  
pp. 35-38
Author(s):  
Shyam Kumar BK ◽  
S.D. Bassi ◽  
Alok Kumar Sah ◽  
Devendra Acharya
Keyword(s):  
Chronic Kidney Disease ◽  
Heart Disease ◽  
Kidney Disease ◽  
Pericardial Effusion ◽  
Diastolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Maintenance Hemodialysis ◽  
P Value ◽  
Lv Diastolic Dysfunction

Objectives: The Aim of this study to assess and analyze the echocardiographic changes in chronic kidney disease patients on maintenance hemodialysis. Material and methods: We Performed Prospective study of echocardiographic changes in chronic kidney disease (CKD) patients undergoing maintenance hemodialysis at our institute. We performed M-mode echocardiography in 80 CKD patients without obvious clinical evidence of coronary artery disease, Valvular heart disease, congenital heart disease. Data was collected from November 2018 to Nov 2019. Results: 80 Patients Undergoing Hemodialysis were included in our study, out of them Echocardiography finding shown LV dilation and diastolic dysfunction in 39 (48.75%), left ventricular hypertrophy (LVH) in 41 (51.25%), systolic dysfunction and pericardial effusion in 22 (27.5%) and 11 (13.75%) patients respectively. RWMA was present in 10% and Valvular calcification was seen in 5 patients. In sub-group of patients with Hb<10 gm%, LVH was present in 32 (78.05%) vs 9 (21.95%) in patient group with Hb ≥ 10 gm% (p <0.01). Other Sub Group of Patients with BP > 140/90mmhg, LVH Was Present in 34 (82.92%) vs 7 (17.08%) in patients group with BP< 140/90 mm hg (p=0.02). In both sub group p value for systolic dysfunction, RWMA & pericardial effusion is statistically not significant. Conclusion: LV diastolic dysfunction and hypertrophy were most common echocardiographic findings. There was statistically significant correlation between anemia and presence of LVH and positive correlation between presence of hypertension and LVH.  

scholarly journals Is hepatojugular reflux a good predictor of heart failure with preserved ejection fraction?

2019 ◽  
Vol 65 (5) ◽  
pp. 592-595
Author(s):  
Guilherme Cristianini Baldivia ◽  
João Vitor Moraes Pithon Napoli ◽  
Josiane Motta e Motta ◽  
Normando Gomes Vieira Filho ◽  
Heno Ferreira Lopes
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Diastolic Dysfunction ◽  
Left Ventricular ◽  
Uncontrolled Blood Pressure ◽  
Volume Increase ◽  
Functional Changes ◽  
Left Atrium Volume ◽  
Lv Diastolic Dysfunction ◽  
Symptoms And Signs

SUMMARY Hypertension may occur with left ventricular (LV) diastolic dysfunction, and the consequence may be symptoms and signs of heart failure (HF). Hepatojugular reflux (HJR), described as a sign of regurgitation of the tricuspid valve, may reflect structural and functional changes of the LV in the hypertensive patient. The signal may be present in the presence of HF. Case: male, 49 years old with uncontrolled blood pressure. Physical examination showed jugular turgescence, HJR, and elevated blood pressure. Complementary exams showed signs of atrial and left ventricular overload in the electrocardiogram and, the echocardiogram showed left atrium volume increase, concentric LV hypertrophy and signs of grade I diastolic dysfunction. DISCUSSIO: The HJR present correlates with pulmonary artery pressure and probably reflect the increase in central blood volume.

scholarly journals Arterial stiffness as a factor of structural and functional cardiac remodeling in obesity

2020 ◽  
Vol 25 (5) ◽  
pp. 3756
Author(s):  
M. A. Druzhilov ◽  
T. Yu. Kuznetsova
Keyword(s):  
Blood Pressure ◽  
Waist Circumference ◽  
Arterial Stiffness ◽  
Diastolic Dysfunction ◽  
Abdominal Obesity ◽  
Cardiac Remodeling ◽  
Left Atrial ◽  
Left Ventricular ◽  
Obese Patients ◽  
Lv Diastolic Dysfunction

Aim. To analyze the association of parameters characterizing the degree of arterial stiffness and echocardiographic criteria for cardiac remodeling in patients with abdominal obesity.Material and methods. The study included 194 patients (men aged 46 to 55 years (49,0±2,3 years)), without hypertension (24-hour average blood pressure (BP) 117,5±5,5/73,0±4,1 mmHg), diabetes and cardiovascular diseases, with abdominal obesity (waist circumference >94 cm, body mass index 31,3±3,5 kg/m2). Lipids and glucose concentrations were evaluated, and glomerular filtration rate was estimated using the CKD-EPI equation. We conducted 24-hour monitoring of blood pressure and arterial stiffness parameters (aortic pulse wave velocity (PWV), augmentation index (AIx) and systolic BP in the aorta), and echocardiography.Results. Left ventricular (LV) hypertrophy was detected in 14 (7,2%) patients, LV diastolic dysfunction — in 36 (18,6%) patients. The correlation of the average aortic PWV and the AIx with the LV mass index and the left atrial volume was shown. Patients with a high aortic PWV exceeding the 75th percentile of distribution (8,2 m/s) were characterized by a higher incidence of hypertrophy (18,8% vs 4,9%,p<0,01) and LV diastolic dysfunction (50,0% vs 12,3%, p<0,001). Patients with/with-out LV hypertrophy and diastolic dysfunction were characterized by higher values of average 24-hour aortic PWV, AIx and systolic BP in the aorta. According to the regression analysis, the predictors of LV diastolic dysfunction were age, waist circumference, aortic PWV, and AIx.Conclusion. The relationship of parameters characterizing the degree of arterial stiffness, primarily, aortic PWV and echocardiographic parameters of the structural and functional cardiac remodeling in obese patients was revealed. Patients with a high aortic PWV (>8,2 m/s for men aged 46-55 years) are characterized by a higher prevalence of LV hypertrophy and diastolic dysfunction, as well as left atrial dilatation. This association is probably a reflection of one of the many pathogenesis links of HF and supraventricular cardiac arrhythmias in obese patients.

scholarly journals Uric Acid Promotes Left Ventricular Diastolic Dysfunction in Mice Fed a Western Diet

Hypertension ◽  
2015 ◽  
Vol 65 (3) ◽  
pp. 531-539 ◽  
Author(s):  
Guanghong Jia ◽  
Javad Habibi ◽  
Brian P. Bostick ◽  
Lixin Ma ◽  
Vincent G. DeMarco ◽  
...  
Keyword(s):  
Uric Acid ◽  
Diastolic Dysfunction ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Western Diet ◽  
Ventricular Diastolic Dysfunction

Increased monocyte to HDL cholesterol ratio in vitamin B12 deficiency: is it related to cardiometabolic risk?

2020 ◽  
pp. 1-8
Author(s):  
Sanem Kayhan ◽  
Nazli Gulsoy Kirnap ◽  
Mercan Tastemur
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Uric Acid ◽  
Vitamin B12 ◽  
Cardiometabolic Risk ◽  
Vitamin B12 Deficiency ◽  
Left Ventricular ◽  
Cardiometabolic Risk Factors ◽  
B12 Deficiency ◽  
Deficiency Group

Abstract. Vitamin B12 deficiency may have indirect cardiovascular effects in addition to hematological and neuropsychiatric symptoms. It was shown that the monocyte count-to-high density lipoprotein cholesterol (HDL-C) ratio (MHR) is a novel cardiovascular marker. In this study, the aim was to evaluate whether MHR was high in patients with vitamin B12 deficiency and its relationship with cardiometabolic risk factors. The study included 128 patients diagnosed with vitamin B12 deficiency and 93 healthy controls. Patients with vitamin B12 deficiency had significantly higher systolic blood pressure (SBP), diastolic blood pressure (DBP), MHR, C-reactive protein (CRP) and uric acid levels compared with the controls (median 139 vs 115 mmHg, p < 0.001; 80 vs 70 mmHg, p < 0.001; 14.2 vs 9.5, p < 0.001; 10.2 vs 4 mg/dl p < 0.001; 6.68 vs 4.8 mg/dl, p < 0.001 respectively). The prevalence of left ventricular hypertrophy was higher in vitamin B12 deficiency group (43.8%) than the control group (8.6%) (p < 0.001). In vitamin B12 deficiency group, a positive correlation was detected between MHR and SBP, CRP and uric acid (p < 0.001 r:0.34, p < 0.001 r:0.30, p < 0.001 r:0.5, respectively) and a significant negative correlation was detected between MHR and T-CHOL, LDL, HDL and B12 (p < 0.001 r: −0.39, p < 0.001 r: −0.34, p < 0.001 r: −0.57, p < 0.04 r: −0.17, respectively). MHR was high in vitamin B12 deficiency group, and correlated with the cardiometabolic risk factors in this group, which were SBP, CRP, uric acid and HDL. In conclusion, MRH, which can be easily calculated in clinical practice, can be a useful marker to assess cardiovascular risk in patients with vitamin B12 deficiency.

scholarly journals Blood pressure reduction after gastric bypass surgery is explained by a decrease in cardiac output

2017 ◽  
Vol 122 (2) ◽  
pp. 223-229 ◽  
Author(s):  
Peter M. van Brussel ◽  
Bas van den Bogaard ◽  
Barbara A. de Weijer ◽  
Jasper Truijen ◽  
C.T. Paul Krediet ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Gastric Bypass ◽  
Body Weight ◽  
Cardiac Output ◽  
Baroreflex Sensitivity ◽  
Bypass Surgery ◽  
Gastric Bypass Surgery ◽  
Left Ventricular ◽  
Ventricular Contractility ◽  
Left Ventricular Contractility

Blood pressure (BP) decreases in the first weeks after Roux-and-Y gastric bypass surgery. Yet the pathophysiology of the BP-lowering effects observed after gastric bypass surgery is incompletely understood. We evaluated BP, systemic hemodynamics, and baroreflex sensitivity in 15 obese women[mean age 42 ± 7 standard deviation (SD) yr, body mass index 45 ± 6 kg/m2] 2 wk before and 6 wk following Roux-and-Y gastric bypass surgery. Six weeks after gastric bypass surgery, mean body weight decreased by 13 ± 5 kg (10%, P < 0.001). Office BP decreased from 137 ± 10/86 ± 6 to 128 ± 12/81 ± 9 mmHg ( P < 0.001, P < 0.01), while daytime ambulatory BP decreased from 128 ± 14/80 ± 9 to 114 ± 10/73 ± 6 mmHg ( P = 0.01, P = 0.05), whereas nighttime BP decreased from 111 ± 13/66 ± 7 to 102 ± 9/62 ± 7 mmHg ( P = 0.04, P < 0.01). The decrease in BP was associated with a 1.6 ± 1.2 l/min (20%, P < 0.01) decrease in cardiac output (CO), while systemic vascular resistance increased (153 ± 189 dyn·s·cm−5, 15%, P < 0.01). The maximal ascending slope in systolic blood pressure decreased (192 mmHg/s, 19%, P = 0.01), suggesting a reduction in left ventricular contractility. Baroreflex sensitivity increased from 9.0 [6.4–14.3] to 13.8 [8.5–19.0] ms/mmHg (median [interquartile range]; P < 0.01) and was inversely correlated with the reductions in heart rate ( R = −0.64, P = 0.02) and CO ( R = −0.61, P = 0.03). In contrast, changes in body weight were not correlated with changes in either BP or CO. The BP reduction following Roux-and-Y gastric bypass surgery is correlated with a decrease in CO independent of changes in body weight. The contribution of heart rate to the reduction in CO together with enhanced baroreflex sensitivity suggests a shift toward increased parasympathetic cardiovascular control. NEW & NOTEWORTHY The reason for the decrease in blood pressure (BP) in the first weeks after gastric bypass surgery remains to be elucidated. We show that the reduction in BP following surgery is caused by a decrease in cardiac output. In addition, the maximal ascending slope in systolic blood pressure decreased suggesting a reduction in left ventricular contractility and cardiac workload. These findings help to understand the physiological changes following gastric bypass surgery and are relevant in light of the increased risk of heart failure in these patients.

Abstract P181: Cardiac Structure is Associated with Obesity and Blood Pressure But Not Inflammation

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Robert A Palermo ◽  
Samuel S Gidding ◽  
Stehpanie S DeLoach ◽  
Scott W Keith ◽  
Bonita Falkner
Keyword(s):  
Blood Pressure ◽  
African American ◽  
Left Ventricular Mass Index ◽  
African American Adolescents ◽  
Female Gender ◽  
Left Ventricular ◽  
P Value ◽  
Cardiac Structure ◽  
Z Score ◽  
Pai 1

Purpose: The aim of this study was to identify risk factors associated with cardiac structure in a cohort of African American adolescents oversampled for obesity and high blood pressure (BP). Additional associations of cardiac structure with a pro-inflammatory adipokine profile (low adiponectin, elevated IL6, PAI-1 and CRP) were sought. Methods: A cross-sectional study was conducted using a two-by-two factorial design with four groups of African American adolescents based on BP (prehypertension or stage 1 hypertension=high BP) and body mass index (BMI > 95% =obese) designation. Measurements included: echocardiogram, anthropomorphics, BP (on 3 separate occasions), high sensitivity CRP and plasma adipokines (adiponectin, IL6, PAI-1). Standardized echocardiogram measurements were used to obtain left ventricular mass index (LVMI, g/m 2.7 ) and left atrial diameter index (LADI, mm/m 2 ). Ordinary least-squares regression with model selection by Mallow's Cp was used to determine if pro-inflammatory adipokine profile predicted LV mass and LA diameter in models including age, gender, BMI z-score, and systolic BP. Results: Data on 251 African American adolescents, ages 13-19, were analyzed. BMI-z score was strongly associated with a pro-inflammatory adipokine profile whereas high BP was not. Variation in LADI was significantly associated with BMI (β=0.12, p<0.01) and female gender (β=0.08, p=0.04). LVMI variation was significantly associated with BMI (β=3.53, p<0.01), age (β=0.71, p<0.01), female gender (β=-4.32, p<0.01), and systolic BP (β=0.10, p=0.03). Though significant in univariate models, inflammatory markers were not significantly associated with LADI or LVMI after BMI adjustment. Conclusions: In African American adolescents, BMI is an important determinant of LADI and LVMI. Obesity is associated with a pro-inflammatory adipokine profile but LADI and LVMI are not. Table. Regression modeling results after variable selection by Mallow C p : Left Atrium Diameter Index and Left Ventricular Mass Index (N = 251) LADI LVMI Estimate (95% CL) p-value Estimate (95% CL) p-value Age (yr) 0.00063 (-0.021, 0.023) 0.955 0.71 ( 0.18, 1.24) 0.009 Gender (F) 0.08 ( 0.01, 0.16) 0.036 −4.32 (-6.13,-2.51) <.001 BMI z-score 0.12 ( 0.08, 0.16) <.001 3.53 ( 2.66, 4.40) <.001 Systolic BP 0.0019 (-0.0017, 0.0055) 0.306 0.0952 ( 0.0085, 0.1819) 0.032

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